Method and device for determining blood flow in a vascular access

ABSTRACT

A method and a device for determining the blood flow Q F  in a vascular access (F) during an extracorporeal blood treatment is described, where the blood enters the blood treatment unit ( 3 ) of the blood treatment machine through an arterial branch ( 19 ) of an extracorporeal circulation loop ( 2 ) which is in fluid connection with the vascular access at an arterial connection. The blood is returned through a venous branch ( 21 ) of the extracorporeal circulation, which is in fluid connection with the vascular access at a venous connection ( 13 ). The blood flow in the vascular access is determined by measuring the pressure P art , P ven , in the arterial and/or venous branch of the extracorporeal circulation when the vascular access is open and interrupted, while the extracorporeal blood flow Q B  is varied. Then the fistula flow Q F  is determined from the measured values for the arterial and/or venous pressure while the vascular access is open and interrupted.

The present invention relates to a method of operating a blood treatmentdevice for determining the blood flow in a vascular access during anextracorporeal blood treatment, and to a device for determining theblood flow in a vascular access during an extracorporeal bloodtreatment.

DESCRIPTION OF RELATED ART

In the methods used for chronic blood purification therapy such ashemodialysis, hemofiltration and hemodiafiltration, blood is sentthrough an extracorporeal circulation loop in a blood treatment unit,such as a dialyzer or filter. To serve as the access to the blood vesselsystem, an arteriovenous fistula is often created surgically and is thengenerally punctured with an arterial needle and venous needle (doubleneedle dialysis). Likewise, use of a vascular implant (PTE graft) isalso possible. The term “vascular access”, as it is used below, isunderstood to refer to any type of access to a patient's blood vessel,but in particular to the connection between a patient's artery and vein.

Typical flows within a satisfactorily functioning vascular access are inthe range of 1100 mL/min. Measurement of blood flow and vascularpressure is of crucial importance to monitoring the functioning of theaccess. Vascular implants showing a flow rate of less than 600 to 800mL/min or an abnormal pressure are associated with a much higher risk ofthrombosis. A thrombosis develops as a result of an unknown stenosiswhich leads to a reduction in blood flow in the vascular access. Throughearly detection of vascular accesses with a reduced blood flow, it istherefore possible to prevent imminent thromboses. In addition, byidentifying vascular accesses with pathologically elevated flow ratesabove 2000 mL/min, overloading of the patient's cardiovascular system isprevented.

German Patent application 4 024 434 A1 describes a device forultrafiltration monitoring in blood purification processes, having apressure measurement device arranged in the extracorporeal bloodcirculation and an analyzer unit where the measured pressure values arestored in chronological order, and where a change in blood viscosity isdeduced from a change in pressure values.

A device for measuring the flow through a fistula is described in GermanPatent 19 541 783 C1. This measurement of fistula flow is based onmeasuring the temperature in the arterial branch of the extracorporealcirculation while there occur variations in extracorporeal blood flow.

Another method of determining the blood flow in a vascular access isbased on a measurement of recirculation before and after exchanging thearterial and venous blood tubes on the needles. This method yields goodclinical results, but has the disadvantage that when the tubes areimproperly exchanged, there is a risk of blood loss and infections, plusa residual pulmonary embolism risk.

In everyday clinical practice, the static pressure in the vascularaccess is measured after turning off the blood pump and theultrafiltration unit. However, when the blood pump is stopped there isthe risk of coagulation in the blood tubing system.

SUMMARY OF THE INVENTION

The present invention provides a method of operating a blood treatmentdevice that makes it possible to determine the blood flow in thevascular system with high reliability, without any technical expense andwithout requiring that the blood tube connections be exchanged. Thisinvention also provides a device that is relatively simple to implementtechnically, so that the blood flow in the vascular access can bedetermined with a high certainty without requiring that the blood tubeconnections be exchanged.

In one aspect, the invention is a method of operating a blood treatmentmachine for determining the blood flow Q_(B) in a vascular access of anextracorporeal circulation during an extracorporeal blood treatment, theblood entering a blood treatment unit of the blood treatment machinethrough an arterial connection of an arterial branch in fluid connectionwith the vascular access, and is returned through a venous connection ofa venous branch in fluid connection with the vascular access. The methodcomprises the steps of measuring pressures P_(art), P_(ven),P_(art comp), P_(ven comp) in one of the arterial or venous branch whilethe vascular access is open and blood flows through said vascular accessbetween the arterial and venous connections, measuring the pressureswhile the vascular access is interrupted and no blood flows through thevascular access between the arterial and venous connections, varyingblood flow Q_(B) in the extracorporeal circulation, and determining theblood flow Q_(F) in the open vascular access between the arterial andvenous connections from the measured values of the pressures P_(art),P_(ven), P_(art comp), P_(ven comp).

In another aspect, the invention is a device for determining blood flowin a vascular access during an extracorporeal blood treatment,comprising an arterial branch of an extracorporeal circulation in fluidconnection with the vascular access at an arterial connection, a bloodtreatment unit for receiving blood from the arterial branch, a venousbranch of the extracorporeal circulation in fluid connection with thevascular access at a venous connection, and a blood pump connected tothe extracorporeal circulation. The device also includes a control unitfor varying the flow rate of the blood pump, at least one of an arterialand a venous measurement device for measuring pressures P_(art),P_(ven), P_(art comp), P_(ven comp) respectively in the arterial andvenous branch of the extracorporeal circulation with the vascular accessopen and with the vascular access interrupted, means for varying a bloodflow Q_(B) in the extracorporeal circulation, a memory unit for storingthe measured arterial and venous pressure, and a computer unit adaptedto determine the blood flow Q_(B) in the open vascular access from themeasured values of the arterial and venous pressure P_(art), P_(ven),P_(art comp), P_(ven comp).

In the method according to this present invention, the blood flow in thevascular access is determined by performing a pressure measurement withan open vascular access while blood flows through the vascular accessbetween the arterial and venous connections. The method also uses aninterrupted vascular access while no blood flows through the same, whilethe blood flow in the extracorporeal circulation is varied. The bloodflow in the open vascular access can then be determined from themeasured values of the pressure in the vascular access that is open andinterrupted. The blood flow can be determined either exclusively fromthe measured values for the pressure in the arterial branch, with thevascular access open and interrupted, or exclusively from the values forthe pressure in the venous branch, with the vascular access open andinterrupted.

However, it is also possible to use both the arterial pressure and thevenous pressure values with both open and interrupted vascular access todetermine the blood flow. The vascular access is preferably pressed byhand between the needles, which offers advantages in practice. Thisprocedure can also be carried out with a compensation tube, a cuff orother similar device.

All measured values can be determined first with the vascular accessopen or interrupted, and only then are all the measured valuesdetermined with the vascular access in the other one of the interruptedor open condition, respectively, while the blood flow is varied withinpredetermined limits. The measured values can be recorded in twosuccessive cycles, one with the vascular access open and one with itinterrupted.

In a first variant of the claimed method, the blood flow can bedetermined in the extracorporeal circulation where the pressure in thearterial or venous branch, with the vascular access interrupted, isequal to the pressure in the arterial or venous branch, respectively,with the vascular access open. This step determines the blood flow inthe open vascular access. In this case, the extracorporeal blood flow isequal to the blood flow in the vascular access. It is advantageous thatonly one pressure measurement, either in the arterial branch or in thevenous branch, is necessary.

A second variant of this method provides for a measurement to beperformed in the arterial and venous branches, to determine the bloodflow in the extracorporeal circulation at which the pressure in thearterial branch having the vascular access interrupted is equal to thearterial pressure having the vascular access open. This method alsodetermines the extracorporeal blood flow at which the venous pressurewith the vascular access interrupted is equal to the venous pressurehaving the vascular access open. The blood flow in the open access isthen advantageously determined by forming the average of these twoextracorporeal blood flow values.

In another variant of this method, the difference between the pressurein the arterial branch having the vascular access interrupted and thepressure in the arterial branch having the vascular access open, and thedifference between the venous pressure having the vascular accessinterrupted and the venous pressure having the vascular access open aredetermined as a function of the extracorporeal blood flow. For the casewhen the two differences are equal to zero, the extracorporeal bloodflow is equal to the blood flow in the open vascular access.

The measured pressure values can be preferably stored in memory inchronological order. The parameters of a function representing thearterial and/or venous pressure as a function of the extracorporealblood flow can be advantageously determined from the discrete measuredvalues. Known mathematical procedures can be used to this end. Dependingon the required accuracy, a larger or smaller number of measured valuesmay be necessary. Outside of the defined limits, the arterial and/orvenous pressure is advantageously determined by extrapolation of thefunction curve, so the blood flow need be varied only within relativelynarrow limits.

The arterial and/or venous static pressure in the vascular access canalso be determined from the measured values for the arterial and/orvenous pressure in the extracorporeal circulation. To do so, byextrapolating the function curve, the arterial and/or venousextracorporeal pressure at which the extracorporeal blood flow is equalto zero is determined.

The invention described here includes an arterial and/or venous pressuremeasurement device for measuring the pressure in the respective arterialand/or venous branches. A control unit can be provided to permitvariation of the extracorporeal blood flow by varying the flow rate ofthe blood pump installed in the extracorporeal circulation. The measuredvalues can be stored in a memory unit. The blood flow in the vascularaccess can be calculated in a computer unit on the basis of the storedmeasured values.

BRIEF SUMMARY OF THE DRAWINGS

Various embodiments of the present invention are described in greaterdetail below with reference to the drawings.

In the Drawings:

FIG. 1: shows a schematic diagram of a device according to the inventionfor determining the blood flow and the static pressure in the vascularaccess together with a dialysis;

FIG. 2: schematically shows the change in pressure and/or flow when thevascular access is interrupted between the arterial and venousconnections, when the blood flow in the vascular access is greater thanthe blood flow in the extracorporeal circulation;

FIG. 3: shows a plot of the pressure in the arterial and/or venousbranches of the extracorporeal circulation with the vascular access openand interrupted, as a function of the extracorporeal blood flow for asimultaneous dialysis treatment;

FIG. 4: shows a plot of the difference between the arterial or venouspressure with an interrupted vascular access and the arterial or venouspressure with an open vascular access, as a function of theextracorporeal blood flow for a simulated dialysis treatment; and

FIG. 5: shows a plot of the arterial or venous pressure as a function ofthe extracorporeal blood flow for a simulated dialysis treatment.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS OF THE INVENTION

The device according to the invention for determining the blood flowQ_(F) in the vascular access (fistula flow) can be assembled, forexample, as a separate component group. However, the device may also bepart of the blood treatment machine, especially since some componentsused in the device are already present in known blood treatmentmachines. The device for determining the fistula flow, together with thenecessary components of the blood treatment machine are described below.In one preferred embodiment, the blood treatment machine can be aconventional dialysis machine.

The dialysis machine can include a dialysis fluid circulation loop 1 andan extracorporeal blood circulation loop 2, between which there is adialyzer 3 which is divided by a semipermeable membrane 4 into adialysis fluid chamber 5 and a blood chamber 6. A dialysis fluid inletline 8 leads from a dialysis fluid source 7 to the inlet of the dialysisfluid chamber, from whose outlet a dialysis fluid outlet line 9 leads toa drain 10. A dialysis fluid pump 11 can be connected to the dialysisfluid outlet line 9 to convey the dialysis fluid.

The patient's fistula F is punctured with arterial and venous needles12, 13. A blood inlet line 14 leads from the arterial connection 12 tothe entrance to the blood chamber 6, while a blood outlet line 15 leadsfrom the outlet of blood chamber 6 to the venous connection 13. A bloodpump 16 which determines the blood flow in the extracorporealcirculation can be connected to the blood inlet line 14 and also to acontrolling unit 18 by a control line 17. The delivery of the blood pump16 can be varied within a certain range with control unit 18.

An arterial pressure measurement device 20 can be provided to measurethe pressure in the arterial branch 19, and a venous pressuremeasurement device 22 can be provided to measure the pressure in thevenous branch 21 of the extracorporeal circulation. The two pressuremeasurement devices are connected by data lines 23, 24 to a memory unit25 where the measured values are stored digitally in chronologicalorder. This memory unit 25 can be connected by a data line 26 to acomputer unit 27 which calculates the fistula flow and the staticpressure in the fistula F from the measured values. The values thusdetermined can be displayed in a display unit 28 which is connected by adata line 29 to the computer unit 27. To control the program flow, thecomputer unit 27 in turn can be connected to the control unit 18 by adata line 30. The computer unit 27 may be, for example, a conventionalmicroprocessor.

During an ongoing dialysis treatment, the arterial and venous pressuresP_(art) and P_(ven) in the extracorporeal circulation loop 2 aredetermined as a function of the extracorporeal blood flow Q_(B).Measurements yield the following functions:

P_(art) (Q_(B)): arterial pressure in the extracorporeal circulation asa function of Q_(B)

P_(ven) (Q_(B)): venous pressure in the extracorporeal circulation as afunction of Q_(B)

After the measurement is concluded, pressure is applied to the vascularaccess between the arterial and venous needles, and the change inextracorporeal pressure is recorded as a function of the extracorporealblood flow. Compression of a vascular access between the needles appliedusing either the fingers or a compression tube is an establishedclinical method of determining vascular resistance. In addition, it hasbeen shown that the cardiac output does not change as a result of briefpressure on the vascular access, if the pressure lasts a time t≦2 min.To prevent artificial fluctuations in pressure, the patient should notmove during the measurements. In addition, preferably there is no changein ultrafiltration rate. Thus, hemodynamic stability can be assumedduring the measurement. These relations yield:

P_(art comp) (Q_(B)): arterial pressure in the extracorporealcirculation loop 2 as a function of Q_(B) after pressing on the vascularaccess.

P_(ven comp) (Q_(B)): venous pressure in the extracorporeal circulationloop 2 as a function of Q_(B) after pressing on the vascular access.

The pressures measured in the extracorporeal circulation loop 2, whilethe blood pump is operating, are composed of the dynamic pressure in theextracorporeal system and the dynamic pressure in the patient's vascularaccess. The dynamic pressure in the extracorporeal system is a functionof the extracorporeal blood flow, the blood viscosity and the sum of theflow resistances in the extracorporeal circulation loop 2. The dynamicpressure in the patient's vascular access is a function of the systemicblood pressure and the systemic vascular flow resistances. The fistulapressure is thus a patient-specific parameter which also depends on thetype of vascular access, the blood viscosity and the vascular systemsupplying blood to the vascular access. By analogy with the dynamicpressure in the extracorporeal system, a change in the fistula pressure,for example due to a fluctuation in blood pressure, to an increase inviscosity or to the patient changing positions, leads to a change inboth the arterial and venous extracorporeal pressure reading.

FIG. 2 shows schematically the flow and pressure conditions before andafter pressing on the fistula. The patient's systemic arterial bloodpressure is available at the arterial needle 12 with the blood pumpturned off and the vascular access pinched. The blood pressure may be,for example in the range of 50 to 150 mm Hg. The pressure at venousneedle 13 corresponds to the venous return pressure in the patient'svascular access (3-15 mm Hg). With the vascular access open, thearterial pressure in the vascular access amounts to approximately 27 mmHg with an intact fistula, and approximately 49 mm Hg with an intactPTFE graft. The venous pressure is approximately 17 mm Hg for thefistula or approximately 35 mm Hg for the graft.

With the blood pump running and the vascular access open, the fistulaflow Q_(F) is usually greater than the extracorporeal blood flow Q_(B).In this case, a reduced fistula flow Q_(F)−Q_(B) flows between theneedles 12-13 in the vessel during the dialysis treatment. For the casewhen the extracorporeal blood flow is greater than the flow in thevessel (Q_(B)>Q_(F)), the difference Q_(F)−Q_(B) is negative, i.e.,there is a recirculation flow from the venous needle to the arterialneedle. In the case when the extracorporeal blood flow is exactly equalto the flow in the vascular access, no blood flows through the vascularaccess between the arterial and venous needles. The three casesQ_(B)<Q_(F), Q_(B)>Q_(F) and Q_(B)=Q_(F) are explained separately below.

Q_(B)<Q_(F): In the case when the reduced flow Q_(F)−Q_(B) between thearterial and venous needles is hindered, a dynamic pressure builds up atthe arterial needle. Therefore, the arterial extracorporeal pressureP_(art comp), increases. In this case, the higher the reduced flowQ_(F)−Q_(B) is, the higher will be the dynamic pressure. On the otherhand, the venous extracorporeal pressure P_(ven comp) will drop, and asa result, the venous pressure drop will also depend on the reduced flowQ_(F)−Q_(B).

Q_(B)=Q_(F): In this limit case, there is no change in pressure and flowconditions when the vessel is pinched between the needles.

Q_(B)>Q_(F): No recirculation occurs when the extracorporeal blood flowis greater than the flow in the vascular access. The recirculation flowfrom the venous to the arterial needle is stopped by compression of thevessel between the needles. This causes a drop in arterialextracorporeal pressure, where the resulting negative pressuredifference depends on the recirculation flow. The venous extracorporealpressure, however, increases slightly, because venous blood is preventedfrom flowing out by suppressing the recirculation flow.

The following table summarizes the arterial and venous pressure changesfor the flow conditions described above.

Delta p_(art.) (Q_(B)) Delta p_(ven.) (Q_(B)) Flow in the vascularaccess + − Q_(B) < Q_(F) 0 0 Q_(B) = Q_(F) − + Q_(B) > Q_(F)

Where:

Delta P _(art)(Q _(B))=P _(art comp)(Q _(B))−P _(art)(Q _(B))  (Equation1)

Delta P _(ven)(Q _(B))=P _(ven comp)(Q _(B))−P _(ven)(Q _(B))  (Equation2)

A qualitative measurement of the flow in the vascular access is possibleby performing a single pressure difference measurement, while thetreatment is underway.

FIG. 3 shows the pressure-flow curve for a simulated dialysis treatmentwith the vascular access open and pinched at a fistula flow of 700±5mL/min. The flow in the extracorporeal circulation is turbulent.Consequently, the function p=f(Q_(B)) is nonlinear, but it can beapproximated with quadratic polynomials of the type y=a+bx+cx² with ahigh correlation.

To measure the function p=f(Q_(B)), the blood flow was varied in therange of between 50 to 550 mL/min, and the respective extracorporealpressure was recorded. Then the functions were curve-fitted using thesecond degree polynomials and were extrapolated. The correlationcoefficients were in the range of R²>0.998.

With the blood pump stopped, the arterial pressure in the open vascularaccess is generally about 34 mm Hg, and the venous pressure isapproximately 32 mm Hg. By compression of the vessel between theneedles, the static arterial pressure is increased to approximately 94mm Hg. This value thus corresponds to the average systemic pressure ofthe arterial system. The static venous pressure drops to approximately 7mm Hg and reflects the return venous pressure. With an increase in bloodflow, the initial pressure difference between the compressed vessel andthe open vessel drops, because the pinched part of the vessel is bridgedby the extracorporeal circulation to an increasing extent.

At the point of intersection of the respective arterial and venousfunction pairs p=f(Q_(B)), it holds that Delta p=0. In the case when theextracorporeal pressure does not change with compression of the vessel,the resulting flow between the needles with the vessel open mustconsequently be zero, i.e., the fistula flow and the extracorporealblood flow are identical. Thus, the fistula flow can be determineddirectly from the point of intersection of the respective Q_(B) value.

The points of intersection of the second-degree polynomial functions arecalculated by the following method. The second-degree polynomial for thepressure-flow curve with the vessel open can be written, for example, asfollows:

y ₁ =a ₁ +b ₁ x+c ₁ x ²  (Equation 3)

With the vessel pinched, the polynomial function can be written as:

y ₂ =a ₂ +b ₂ x+c ₂ x ²  (Equation 4)

Equating equation 3 with equation 4 yields:

a ₁ +b ₁ x+c ₁ x ² =a ₂ +b ₂ x+c ₂ x ²  (Equation 5)

After converting:

(a ₁ −a ₂)+(b ₁ −b ₂)x+(c ₁ −c ₂)x ²=0  (Equation 6)

With the following substitutions:

(a₁−a₂)=A

(b₁−b₂)=B

(c₁−c₂)=C

the following two solutions are obtained for the mixed quadraticequation 6: $\begin{matrix}{x_{1} = \frac{{- B} + \sqrt{B^{2} - {4{AC}}}}{2C}} & \left( {{Equation}\quad 7} \right) \\{x_{2} = \frac{{- B} - \sqrt{B^{2} - {4{AC}}}}{2C}} & \left( {{Equation}\quad 8} \right)\end{matrix}$

Equation 6 has two solutions which may either be different and real,identical and real or conjugated and complex. The selection of whichcase occurs is made according to the discriminant D:

D=B ²−4AC  (Equation 9)

If D is positive, there are two different real solutions. If D=0, thereis a real double solution. However, if D is negative, equation 4 has twoconjugated complex solutions. In the present case, D is always positive,so equation 4 supplies two different real points of intersection. Ofthese, only x>0 values are of physical interest, representing positiveextracorporeal blood flow. Thus, the point of intersection in thepressure-flow curves being sought is defined by the positive solution ofequations 7 and 8.

The following table summarizes the constants of the fitting computationsof the type y=a+bx+cx² of the pressure-flow curve p=f(Q_(B)) shown inFIG. 3.

Pressure-flow curve a b c R² Arterial with open 30.0714 −0.07591−6.66965 · 10⁻⁴ 0.99915 vessel Arterial with 88.40084 −0.13109  −7.050 ·10⁻⁴ 0.99970 pinched vessel Venous with open 19.45073 0.08208   8.70911· 10⁻⁴ 0.99988 vessel Venous with −3.11153 0.0633   9.45423 · 10⁻⁵0.99994 pinched vessel

Inserting the respective values into equation 6 and performing thecalculation according to equations 7 and 8 yields the points ofintersection derived from the following table:

Intersection Derived Intersection Derived Value pair From eq. 7 From eq.8 Arterial pressure-flow curve 723 mL/min −2284 mL/min Venouspressure-flow curve −439 mL/min 691 mL/min

The fistula flow is calculated by averaging the appropriate solutions.In the range of positive flow, the average of the calculated flow in thevascular access is 707±23 mL/min.

FIG. 4 shows an alternative plot of the pressure measurement with thevascular access open and pinched. The pressure difference Delta p isplotted here as a function of the effective extracorporeal blood flowaccording to equations 1 and 2. The measured data were again fitted withsecond-degree polynomials. In the case when the extracorporeal pressurewith the fistula open is the same as that with the fistula pinched(Delta p=0), extracorporeal blood flow and flow in the vascular accessare identical. Consequently, the fistula flow can be determined from thecommon point of intersection of the polynomials, and also from thepoints of intersection of the individual polynomials with the x axis.The following table summarizes the constants of the curve-fittingcalculation of the type y=a+bx+cx² from FIG. 4.

Pressure difference a b c R² Delta p_(art) = (Q_(B)) 58.24088 −0.05247−4.04643 · 10⁻⁵ 0.98834 acc. to eq. 1 Delta p_(ven) = (Q_(B)) −22.90486−0.0149 −6.44045 · 10⁻⁵ 0.9222 acc. to eq. 2

Calculation of the point of intersection of the polynomials illustratedin FIG. 4 according to equations 7 and 8 yields a flow value ofQ_(F)=719 mL/min. The points of intersection of the polynomials with thex axis can be calculated by equating the y value to zero:

a+bx+cx ²=0  (Equation 10)

By analogy with equation 6, the solution of the mixed quadratic equation10 can thus be calculated from equations 7 and 8. The respective Q_(F)values are 715 mL/min (from the arterial curve in FIG. 4) and 723 mL/min(from the venous curve in FIG. 4). In the method of fistula flowmeasurement, the arterial and venous pressures in the extracorporealcirculation can be recorded as a function of extracorporeal blood flowQ_(B), while the dialysis treatment is underway.

The statistical determination of the static arterial and venous pressurecan be carried out as follows. The function(s) p_(art) (Q_(B)) andp_(ven) (Q_(B)) are curve-fitted with quadratic polynomials of the typey=a+bx+cx². Then the y axis intercept a of the arterial and venouspressure-flow curves is calculated. The extracorporeal pressure is equalto the static pressure in the vascular access plus the hydrostaticpressure which comes about due to the differences in height between theextracorporcal pressure sensor and the vascular access. A pressuredifference of approximately 0.77 mm Hg per cm of height difference canbe assumed to be a good approximation.

FIG. 5 shows the function value of the arterial and venous pressure-flowcurve p=f(Q_(B)) for a simulated dialysis treatment and the respectivemathematical curve-fitting. Although the function p=f(Q_(B)) is notlinear, it can be curve-fitted with quadratic polynomials of the typey=a+bx+cx² with a high correlation. By using x=0 as a boundarycondition, y=a can be obtained, meaning that the point of intersectionof the polynomial with the y axis can be defined by the polynomialconstant a. The parameters shown in the following table can be obtained:

Pressure-flow curve a b c R² Arterial extra- 30.0714 −0.07591 −6.66965 ·10⁻⁴ 0.99915 corporeal pressure Venous extra- 19.45073 0.08208 8.709711· 10⁻⁴ 0.999888 corporeal pressure

The operation of the device for determining the fistula flow and thestatic arterial and venous pressure is described as follows. During thedialysis treatment, the control unit 18 initiates the measuring process,so that the blood flow Q_(B) is increased continuously from a lowerlimit value within a predetermined range up to an upper value due to achange in the flow rate of the blood pump 16. As a result, venouspressure P_(art), P_(ven) is measured by the arterial or venous pressuremeasuring device 20,22. The measured values are stored in memory unit25. Then the vascular access is pinched off between the arterial andvenous needles. Control unit 18 then reduces the extracorporeal bloodflow down to a lower limit value after starting from the upper limitvalue, for example, after confirmation being issued by the operatingpersonnel, and then the arterial and venous pressure P_(art comp) andP_(ven comp) are measured again. The measured values can also be storedin memory unit 25. Computer unit 27 then can read out the storedmeasured values, and can calculate the fistula flow Q_(F) and the staticarterial and venous pressure in the fistula from the measured values,using one of the algorithms described above. The fistula flow and thefistula pressure can then be displayed on display unit 28.

What is claimed is:
 1. A method of operating a blood treatment machine for determining a blood flow Q_(F) in a vascular access of an extracorporeal circulation during an extracorporeal blood treatment, wherein blood entering a blood treatment unit of the blood treatment machine through an arterial connection of an arterial branch is in fluid connection with the vascular access, and is returned through a venous connection of a venous branch in fluid connection with the vascular access, the method comprising the steps of: measuring at least one pair of pressures selected from the group consisting of p_(art), p_(art comp) and p_(ven), p_(ven comp), wherein p_(art), p_(art comp) are, respectively, the arterial branch pressure while the vascular access is open and blood flows through said vascular access between the arterial and venous connections, and while the vascular access is interrupted and no blood flows through the vascular access between the arterial and venous connections, while a blood flow Q_(B) in the extracorporeal circulation is varied, and wherein p_(ven), p_(ven comp) are, respectively, the venous branch pressure while the vascular access is open and blood flows through said vascular access between the arterial and venous connections, and while the vascular access is interrupted and no blood flows through the vascular access between the arterial and venous connections, while the blood flow Q_(B) in the extracorporeal circulation is varied; and calculating the blood flow Q_(F) in the open vascular access between the arterial and venous connections from the measured values of the at least one pair of pressures selected from the group consisting of p_(art), p_(art comp) and p_(ven), p_(ven comp).
 2. The method according to claim 1, further comprising the steps of: varying the blood flow Q_(B) in the extracorporeal circulation while the vascular access is open; measuring at least one of the pressures p_(art), p_(ven) in the respective arterial and venous branches; storing at least one of the pressures p_(art), p_(ven) measured with the vascular access open; interrupting the vascular access between the arterial and venous connections; varying the blood flow Q_(B) in the extracorporeal circulation while the vascular access is closed; measuring at least one of the pressures p_(art comp), p_(ven comp) in the respective arterial and venous branches; and storing at least one of the pressures p_(art comp), p_(ven comp) measured with the vascular access closed.
 3. The method according to claim 1, further comprising the step of: determining the blood flow in the open vascular access by measuring the blood flow Q_(B) in the extracorporeal circulation in a condition when the pressure p_(art comp) in the arterial branch with the vascular access interrupted is substantially equal to the pressure p_(art) in the arterial branch with the vascular access open.
 4. The method according to claim 1, further comprising the step of: determining the blood flow in the open vascular access by measuring the blood flow Q_(B) in the extracorporeal circulation at which the pressure p_(ven comp) in the venous branch with the vascular access interrupted is substantially equal to the pressure p_(ven) in the venous branch with the vascular access open.
 5. The method according to claim 1, further comprising the step of: measuring a first blood flow in the extracorporeal circulation at which the pressure p_(art comp) in the arterial branch with the vascular access interrupted is substantially equal to the pressure p_(art) in the arterial branch with the vascular access open; measuring a second blood flow in the extracorporeal circulation at which the pressure p_(ven comp) in the venous branch with the vascular access interrupted is equal to the pressure p_(ven) in the venous branch with the vascular access open; and determining the blood flow in the open vascular access using the first and second flows.
 6. The method according to claim 5, further comprising determining the blood flow in the open vascular access by averaging the first and second blood flow values.
 7. The method according to claim 1, further comprising determining the blood flow in the open vascular access by measuring a value of the extracorporeal blood flow Q_(B) at which a difference Delta p_(art) between a pressure in the arterial branch with the vascular access interrupted and a pressure in the arterial branch with the vascular access open is equal to zero.
 8. The method according to claim 1, further comprising determining the blood flow in the open vascular access by measuring a value of the extracorporeal blood flow Q_(B) at which a difference Delta p_(ven) between a pressure in the venous branch with the vascular access interrupted and a pressure in the venous branch with the vascular access open is equal to zero.
 9. The method according to claim 1, further comprising the step of determining one of the arterial and venous static pressure in the vascular access by measuring a respective arterial and venous pressure p_(art), p_(ven) in the extracorporeal circulation at which blood flow in the extracorporeal circulation is equal to zero.
 10. The method according to claim 1, further comprising; measuring open values for the arterial and venous pressure in the respective arterial and venous branch of the extracorporeal circulation with the vascular access open; measuring interrupted values for the arterial and venous pressure in the respective arterial and venous branch of the extracorporeal circulation with the vascular access interrupted; and determining parameters of a function p(Q_(B)) representing arterial and venous pressure as a function of the extracorporeal blood flow Q_(B) from the respective open and interrupted values. 